Bereavement Leave Request Form Template

Who this template is for

Bereavement leave is one of the few HR workflows where the policy details matter less than the human response. An employee submitting a bereavement request is going through one of the most difficult moments of their life; the last thing they need is a 12-field form asking for the deceased's full name, the death certificate upload, and a manager's signature loop that takes 3 days to approve. The companies that handle bereavement well treat it as a no-questions-asked workflow with reasonable trust — submit, take the time you need, return when ready, manager keeps your work covered, no documentation gating. The legal floor varies by jurisdiction: US has no federal bereavement leave mandate (the FMLA does not cover bereavement, only the underlying medical conditions); California AB 1949 (effective 2023) requires 5 unpaid days for employers with 5+ employees, expanded by SB 848 to reproductive-loss leave; Oregon, Illinois, Maryland, Washington have similar laws; Spain's Estatuto de los Trabajadores Art. 37.3.b provides 2 days for death of spouse, parent, child, sibling, in-laws (extendable to 4 days with travel out of locality), fully paid; Brazil's CLT Art. 473 §I provides 2 consecutive days (gala bereavement) for death of spouse, ancestor, descendant, sibling, or person under economic dependency. This template structures the request with the minimum friction — employee identity, relationship to deceased (the field that drives the day allowance under the applicable law), leave start date and expected return date, manager notification, and an optional 'additional information' field for context the employee chooses to share but is not required. It is the structured intake your HR team uses while respecting the employee's bandwidth — not the bureaucratic intake that asks for the deceased's social security number, the funeral home contact, and proof of attendance.

From loss to time off in one structured, low-friction request

Employee submits the request with their identity (name + work email + department for routing), relationship to deceased (which determines the day allowance under the applicable jurisdiction — US state law / Spanish convenio / Brazilian CLT), leave start date (typically the day of or day after notification of death), expected return date (defaults to the maximum under the applicable jurisdiction with the option for the employee to take less or request more), manager name (auto-filled from the directory), and an optional 'additional information' field for context the employee chooses to share. No death certificate upload is required by default — the trust-by-default approach is the modern best practice and the legal floor in most jurisdictions does not require employer-verified documentation. On submission, the workflow auto-approves under the per-jurisdiction day allowance (US California AB 1949: 5 unpaid days, can be intermittent; Spain: 2 paid days, extendable to 4 with travel; Brazil CLT Art. 473 §I: 2 consecutive paid days for the listed relationships) and routes a notification to the manager + HR for awareness only (not approval-gated unless the requested days exceed the allowance, in which case routing to manager for the additional discretionary days). The manager receives a notification with the leave dates and a one-click 'set OOO and cover team duties' option that triggers the standard out-of-office workflow — auto-replies for the employee's email, calendar block for the leave period, Slack status update, optional handoff message to the immediate team. HR receives the notification with the time-off tracking record updated for payroll continuity. The employee receives a confirmation with the approved dates, the policy summary (paid days vs. unpaid, ability to extend with PTO, the company's Employee Assistance Program EAP contact for grief counseling, the bereavement-leave-specific benefits if any). No friction for the standard request; manager approval only if the request extends beyond the policy allowance. Return-to-work is also smooth — no documentation required, the employee returns when the expected return date arrives or notifies the manager if they need to extend.

What's included

Every field exists because some HR team has learned the hard way about the design tradeoffs — but every field is also kept minimal because the form is being filled out by someone who has just experienced a loss. Documentation requirements are deliberately light; the trust-by-default approach is both more humane and a better predictor of long-term retention than the documentation-heavy alternative.

Employers using bereavement leave forms

• Mid-market and enterprise employers (US 5+ states)

  US employers operating across multiple states where bereavement leave requirements vary by state — California AB 1949 (5 unpaid days for 5+ employee employers), Oregon (2 weeks per qualifying death, up to 60 days total per year), Illinois (Family Bereavement Leave Act, 2 weeks for pregnancy loss or child loss), Maryland (3 days unpaid for certain family deaths), Washington (3 days for child or spouse), and growing list of states adopting similar laws in 2023-2026. The form respects the per-state minimum and the company's standard policy (typically 3-5 paid days as a floor, expanded for immediate family). Pairs naturally with multi-state HRIS platforms — BambooHR, Workday HCM, Rippling, Gusto, ADP Workforce Now — that track the time-off accrual and policy compliance.

• Spanish employers under Estatuto de los Trabajadores

  Spanish employers subject to Article 37.3.b of the Estatuto de los Trabajadores which provides paid bereavement leave (permiso por fallecimiento) — 2 days for death of cónyuge, padres/madres, hijos/hijas, hermanos/hermanas, abuelos/abuelas, nietos/nietas, suegros/suegras, cuñados/cuñadas (parents-in-law, brothers/sisters-in-law), extendable to 4 days when the death occurs in a different locality requiring travel. The Estatuto Art. 37 was amended by Ley 5/2023 (la Ley de Familias) to expand the list of relationships and clarify the calculation rules. Many convenios colectivos extend these minimums — the metal convenio, hostelería convenio, comercio convenio, construcción convenio typically add 1-3 additional days. The form respects the per-relationship minimum, calculates the extension for travel, and integrates with the Spanish HRIS / nómina stack (Holded, Factorial HR, Personio Spain, Sage HR Spain, Cezanne HR, Bizneo, A3 Nom de Wolters Kluwer).

• Brazilian employers under CLT Art. 473

  Brazilian employers subject to Article 473 §I of the CLT (Consolidação das Leis do Trabalho) which provides 2 consecutive paid days (faltas justificadas) for the death of: cônjuge, ascendentes (pais, avós), descendentes (filhos, netos), irmãos, or pessoa que viva sob dependência econômica do empregado (provable by declaration). The form respects the CLT floor and the typical convenção coletiva or acordo coletivo extensions (some sectors provide 3-5 days; some companies expand to include in-laws explicitly even though the CLT does not list them). For empresas em regime CLT, the time-off is paid and does not affect the férias or 13º salário calculation. For empresas com regime PJ, the bereavement is handled via contract terms and the form serves as the formal notification rather than as paid-time-off. Integrates with Brazilian HRIS / folha stack (Convenia, Sólides, Senior Sistemas, TOTVS RH Folha, Folha Certa, ContaSimples Folha, Pontotel) and generates the eSocial S-2230 (Afastamento Temporário) event with the appropriate motive code.

• Reproductive-loss-leave-extending employers (post-2023 US)

  US employers extending bereavement to reproductive loss following California SB 848 (effective 2024 — 5 days unpaid for miscarriage, stillbirth, failed adoption, failed surrogacy, failed IUI/IVF cycle), Illinois Family Bereavement Leave Act (2 weeks for pregnancy loss or child loss), New York State Paid Family Leave (effective 2024 for pregnancy loss), and a growing list of states. The form's relationship-to-deceased field is configured to include reproductive-loss as a category with the appropriate day allowance under the applicable state law, while preserving the option for the employee to not specify the precise nature of the loss (which respects the privacy of fertility journeys and miscarriage that many employees prefer to handle without detailed HR disclosure). The trend in 2024-2026 is clearly toward expansion — the form is structured for the policy expansion without requiring re-deployment as new states adopt similar laws.

• Modern employers with expanded family definitions

  Modern employers (particularly tech, creative agencies, modern services firms) expanding bereavement to honor expanded family definitions — chosen family (close friends, mentors, partners-not-married), pet bereavement (pets are family in many households; some progressive policies offer 1-2 days for the loss of a pet that lived with the employee), step-family and in-law expansion beyond the CLT/Estatuto floor, and the broader bereavement that comes with extended family that was structurally important even if not legally categorized as close family. The form's relationship-to-deceased field is configured with the company's actual extended definitions while maintaining the legal-floor allowances for the recognized categories. The trust-by-default approach particularly matters here because the employee is the one who knows whether a particular loss is significant enough to require leave, regardless of whether the deceased was legally a 'family member' under the narrow statutory definitions.

• EAP integration and grief support services

  Employers offering Employee Assistance Programs (EAP) — typically provided by ComPsych, Lyra Health, Spring Health, Modern Health, Magellan Health, Optum EAP for US; AMBA, Salud y Familia for Brazil; Pyramid Salud, Sanitas Empresas EAP for Spain — where bereavement is one of the primary trigger events for grief counseling. The form integrates with the EAP referral by including the EAP contact in the confirmation email and offering the optional 'connect me with grief counseling' opt-in that triggers the EAP outreach. For employers with comprehensive bereavement support (some progressive policies offer paid time for funeral attendance for non-immediate family, attendance at memorial services that may be weeks or months later, etc.), the form's date fields support the non-immediate timing patterns rather than requiring the leave to be 'immediately after the death.'

Tailor it to your bereavement policy

Every company has its own bereavement policy nuances. Configure the relationship-to-deceased options to match your policy definitions — most companies use Spouse/Partner / Parent / Child / Sibling / Grandparent / In-law as the standard categories; progressive policies add Chosen Family / Pet / Reproductive Loss / Other; conservative policies stick to the statutory minimum. Configure the per-relationship day allowance to match your policy — typical US standards are 5 days for immediate family (spouse, parent, child), 3 days for extended family (sibling, grandparent), 1 day for in-laws and friends; Spanish standards under Estatuto Art. 37 are 2 days (extendable to 4 with travel); Brazilian standards under CLT Art. 473 §I are 2 days for the listed relationships. Configure the documentation requirement — the modern best practice is no documentation required (trust-by-default), but some employers require death certificate or obituary for leaves beyond the statutory minimum (typically a verification rather than an approval gate). Configure the manager-approval workflow — most policies auto-approve within the statutory + standard allowance and require manager approval only for the discretionary extension; some companies route all bereavement requests through manager notification without approval-gating. Add the EAP referral integration if you offer grief counseling — the confirmation email can include the EAP contact and the optional opt-in for the EAP outreach. Configure the return-to-work logic — modern policies allow the employee to extend the leave if needed without re-applying (a one-click 'extend by N days' option from the original confirmation email), while traditional policies require a new request. For multi-country companies, configure the per-country branching so the form respects the local statutory floor while maintaining the company's global minimum policy (typically the highest jurisdiction sets the floor for all employees, which is more generous than the strict 'each country gets its own minimum' approach). Add the OOO (out-of-office) auto-coordination — on approval, the form triggers the auto-reply for the employee's email, the calendar block, the Slack status update, the team handoff message. Integrate with your HRIS / time-off platform — BambooHR, Workday HCM, Personio, Factorial HR, Holded, Rippling, Gusto, Convenia, Sólides, Senior Sistemas — for the time-off tracking and the eSocial S-2230 / Modelo 145 family-status update if relevant.

Bereavement leave FAQs

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